Vocal Cord Function Return After Larynx Preservation is Associated With Recurrence-Free Probability.

OBJECTIVES: Vocal cord fixation is one of the main upstaging features of laryngeal cancer. In our previously conducted retrospective study, vocal cord (VC) mobility restoration after chemoradiotherapy was a favorable prognostic variable. In this prospective study, we examined the significance of VC mobility restoration after definitive treatment as a prognostic variable. METHODS: In this prospective cohort study, we enrolled 30 patients with squamous cell carcinoma of the larynx with VC impairment/fixation (T2/3, T4a) who underwent definitive chemoradiotherapy with complete response. Video laryngoscopy before and at 3 months after treatment was used to evaluate VC mobility. The primary endpoint of the study was the local recurrence-free probability. Secondary endpoints included recurrence-free probability, disease-specific survival (DSS), and overall survival (OS). RESULTS: The median age of patients was 62 years (IQR 54-67). The primary subsites were the glottis (n = 13) and supraglottis (n = 14). After treatment, 18 (60%) patients had a full recovery of VC mobility, and 12 (40%) patients' VCs were fixed or impaired. Five-year local recurrence-free probability was worse in the VC-impaired group compared to a group with restored VC mobility (46% vs. 85%, p = 0.012). Recurrence-free probability, OS, and DSS differences were not statistically significant in both groups. VC mobility restoration predicted local recurrence-free probability on univariable analysis (HR 6.15, 95% CI 1.23-30.6). CONCLUSION: In this prospective study, we show that the absence of VC mobility restoration is associated with worse local recurrence-free probability after definitive laryngeal preservation treatment. Patients with persistent vocal cord immobility warrant closer follow-up to detect recurrence early. LEVEL OF EVIDENCE: III Laryngoscope, 2024.

Impact of Dementia on the Postoperative Outcomes in Patients Undergoing Surgery for Head and Neck Cancers: A National Study.

BACKGROUND: Dementia, a growing concern among the elderly, has an increased poor postoperative outcome that goes unrecognized by many. Our study aims to establish if dementia plays a role in the outcomes of head and neck cancer patients that undergo resections. METHODS: We queried the National Inpatient Sample (NIS) database from 2016 to 2019 with a primary diagnosis of head and neck cancer who underwent surgical resection. Outcomes analyzed include postoperative delirium, ICU stay, complications, length of stay, and non-routine discharge. RESULTS: A total of 77095 patients were included, of which 1140 patients had dementia. The mean age of the patients with dementia was 77.5 years (±9.1) versus 63.2 years (±12.1) with no dementia. Dementia patients had a higher non-home discharge rate (77.2% vs 46.8%, p = <0.001), extended length of stay (10.9 days ±14.7 vs 7.9 days ±8.8), postoperative delirium (15.4% vs 1.5%, p = <0.001), and longer ICU stay (8.3% vs 5.8%) as compared with patients with no dementia. A higher number of patients with Dementia were placed in long-term facilities (53.5% vs 14.6%) postoperatively. More dementia patients (7.9% vs 0.9%) were transferred in from another health care facility for surgery. Dementia was associated with higher odds of delirium (OR, 6.36; 95% CI, 5.2-7.77), non-routine discharge (OR, 2.05; 95% CI, 1.76-2.3), ventilation (OR, 0.8; 95% CI, 0.6-1.05), and length of stay (estimate 3.01, 95% CI, 1.84-4.184). CONCLUSION: Preoperative dementia significantly impacts postoperative delirium, non-home discharge, and extended length of stay in head and neck cancer patients undergoing surgery. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1258-1264, 2024.

Utility of hospital frailty risk score in predicting postoperative outcomes of sinonasal malignancies.

KEY POINTS: Hospital frailty risk score (HFRS) correlates with complications, length of stay, and non-routine discharge. HFRS is a better predictor of postsurgical sequelae than age and Elixhauser comorbidity index.